WebMD Health News
Louise Chang, MD
Aug. 27, 2009 -- Psoriasis can lead to physical scars, but the emotional scars from the skin disease can run deeper.
The thick, red, scaly skin lesions that characterize the condition often influence how people with psoriasis feel about themselves and how others see them.
Now new early research suggests that the brains of some patients may actually adapt to cope with the body image and self-esteem issues that can accompany the skin disorder.
Using brain imaging focused on an area of the brain believed to control feelings and reactions to disgust, researchers in the U.K. showed that psoriasis patients tended to react less strongly to facial expressions registering disgust than people without the skin condition.
The study was small, with just 12 men with psoriasis and 12 men without the skin condition.
But the findings suggest the brains of psoriasis patients eventually become rewired to protect against the negative emotional responses of others, researchers say.
The research appears in the latest issue of the Journal of Investigative Dermatology.
"Psoriasis can be a very stigmatizing condition, but this is often not factored in to decisions about treatment," dermatologist and study researcher C. Elise Kleyn of the University of Manchester tells WebMD.
She says a clear understanding of how psoriasis affects a patient's psychological state is important for determining how aggressive treatment should be.
Dermatologist Jason Reichenberg, MD, of the University of Texas Medical Branch at Austin, agrees.
He says clinicians still typically focus on how much of the body is affected by psoriasis when they make decisions about treatment. The National Psoriasis Foundation defines mild psoriasis as affecting less than 3% of the body. Skin coverage of 3% to 10% is considered moderate, and coverage of more than 10% is considered severe.
Treatments for the skin disorder run the gamut, from moisturizers, coal tar, and other remedies to immune-system targeting biologics.
Studies suggest that doctor and patient assessments of psoriasis severity often diverge, Reichenberg says.
"Having a circle of psoriasis the size of a quarter on the forehead is going to have a different impact than the same-sized circle on a largely hidden part of the stomach," he says. "I see patients who are so paralyzed by this that they are unable to have intimate contact with other people."
He adds that there is a growing awareness among dermatologists of the importance of considering the psychological impact of psoriasis when making decisions about treatment.
And several small studies suggest that efforts to improve a patient's psychological state, such as treating with antidepressants or teaching relaxation techniques, can improve treatment outcomes.
Studies show that a large percentage of psoriasis patients are unhappy with the treatments they are getting, Reichenberg says.
"I would urge patients who are having trouble dealing with the psychological aspects of their psoriasis to make their feelings known to their physician," he says. "More and more patients are doing this, and taking control of their treatment."
SOURCES:Kleyn, C.E. Journal of Investigative Dermatology, online edition.C. Elise Kleyn, MD, dermatological sciences, University of Manchester,
England.Jason Reichenberg, MD, associate program director, department of
dermatology, University of Texas Medical Branch, Austin.News release, Journal of Investigative Dermatology, Nature Publishing
Group.National Psoriasis Foundation, Psoriasis statistics.WebMD Medical Reference: "Understanding Psoriasis - the Basics."
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